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Original Research: Chest Infections |

Risk of Mycobacterial Infections Associated With Rheumatoid Arthritis in Ontario, CanadaMycobacterial Infections and Rheumatoid Arthritis

Sarah K. Brode, MD; Frances B. Jamieson, MD; Ryan Ng, MSc; Michael A. Campitelli, MPH; Jeffrey C. Kwong, MD; J. Michael Paterson, MSc; Ping Li, PhD; Alexandre Marchand-Austin, BSc; Claire Bombardier, MD; Theodore K. Marras, MD
Author and Funding Information

From the Joint Division of Respirology (Drs Brode and Marras), Department of Medicine and Toronto Western Family Health Team (Dr Kwong), University Health Network and Mount Sinai Hospital, Toronto; Westpark Healthcare Centre (Dr Brode), Toronto; Department of Medicine (Drs Brode and Marras), Department of Laboratory Medicine and Pathobiology (Dr Jamieson), Department of Family and Community Medicine (Dr Kwong), and Institute of Health Policy (Mr Paterson and Dr Bombardier), Management and Evaluation, University of Toronto, Toronto; Public Health Ontario (Drs Jamieson and Kwong and Mr Marchand-Austin), Toronto; Institute for Clinical Evaluative Sciences (Messrs Ng, Campitelli, and Paterson and Drs Kwong and Li), Toronto; Department of Family Medicine (Mr Paterson), McMaster University, Hamilton; and Toronto General Hospital Research Institute (Dr Bombardier), Toronto, ON, Canada.

CORRESPONDENCE TO: Theodore K. Marras, MD, Toronto Western Hospital, 7E 452, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada; e-mail: ted.marras@uhn.ca


FOR EDITORIAL COMMENT SEE PAGE 529

Part of this article was presented in abstract form (Brode SK, Jamieson FB, Ng R, et al. Am J Respir Crit Care Med. 2013;187:A3793).

FUNDING/SUPPORT: The Grant-in-Aid Program of the Ontario Thoracic Society and Ontario Lung Association funded this research. This research was also supported by the Institute for Clinical Evaluative Sciences, a nonprofit research institute funded by the Ontario Ministry of Health and Long-Term Care.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(3):563-572. doi:10.1378/chest.13-2058
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OBJECTIVE:  Patients with rheumatoid arthritis (RA) are at increased risk of TB. Little is known about the risk of nontuberculous mycobacteria (NTM) disease in these patients. We sought to ascertain the rate of NTM infection and TB in all residents of Ontario, Canada, with and without RA.

METHODS:  In a cohort study, all Ontarians aged ≥ 15 years in January 2001 were followed until December 2010. Individuals with RA were identified using a validated algorithm to search hospitalization and physician billing claims. We linked Public Health Ontario Laboratory data to identify all cases of laboratory-confirmed TB and NTM disease. Analysis was performed using Cox proportional hazards regression.

RESULTS:  We identified 113,558 Ontarians with RA and 9,760,075 Ontarians without RA. Relative to the non-RA group, adjusted hazard ratios (HRs) and 95% CIs for TB (1.92, [1.50-2.47]) and NTM disease (2.07, [1.84-2.32]) demonstrated increased risks in the RA group. Among those with RA, per 100,000 person-years, NTM disease (HR, 41.6; 95% CI, 37.1-46.5) was more common than TB (HR, 8.5; 95% CI, 6.5-10.8). After full adjustment, people with RA who developed NTM disease were 1.81 times as likely to die than uninfected people with RA.

CONCLUSIONS:  Mycobacterial infections are more common in Ontarians with RA, with NTM disease more likely than TB. NTM disease is associated with an increased risk of death in patients with RA. Given the rising rates of NTM disease worldwide, determining whether this risk is due to the use of immunosuppressive medications vs RA itself is an important objective for future research.

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